Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment

• DOI: 10.1016/j.jagp.2024.05.006
• Publication Date: 2024-05-17T18:12:50Z
• Authors: Julia Müller; Moritz Elsaesser; Wiebke Müller; Martin Hellmich; Magdalena Hammen; Nadine Zehender; Steffi Riedel-Heller; Bettina H. Bewernick; Michael Wagner; Lutz Frölich; Oliver Peters; Forugh S. Dafsari; Katharina Domschke; Frank Jessen; Martin Hautzinger; Elisabeth Schramm
• Keywords: non-specific supportive intervention; Male; Aged, 80 and over; psychology [Adult Survivors of Child Abuse]; Cognitive Behavioral Therapy; Depression; Adult Survivors of Child Abuse; childhood maltreatment; 150; 610; psychology [Child Abuse]; Middle Aged; cognitive behavioral therapy; late-life depression; Treatment Outcome; early trauma; older age; Humans; Female; ddc:610; Child Abuse; therapy [Depression]; methods [Cognitive Behavioral Therapy]; Aged

This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD).This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS).In the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F(1,201.31) = 4.71; p = .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype 'physical neglect' was associated with a smaller depressive symptom reduction (F(1,207.16) = 5.37; p = .021).Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.